Veterans diagnosed with any psychiatric illness appear to have an elevated risk of suicide, and men with bipolar disorder and women with substance abuse disorders may have a particularly high risk, according to a report in the November issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
An estimated 90 percent to 98 percent of individuals who die from suicide meet criteria for at least one psychiatric disorder, according to background information in the article. "Prior research has consistently found associations between psychiatric conditions (e.g., depression, bipolar disorder, posttraumatic stress disorder [PTSD], schizophrenia and alcohol and/or drug use disorders) and risk of fatal and non-fatal suicide attempts," the authors write. However, determining the association between individual psychiatric conditions and suicide risk has been difficult, in part because of the low numbers of suicides in many research studies.
The Veterans Affairs Healthcare System is the largest single healthcare system in the country, and recent research indicates veterans have an elevated risk of suicide when compared to the general population, the authors note. Mark A. Ilgen, Ph.D., and colleagues at the Department of Veterans Affairs (VA) Healthcare System and the University of Michigan, Ann Arbor, examined the associations between different types of psychiatric diagnoses and suicide risk among more than 3 million veterans who received any type of care at a VA facility in 1999 and were alive at the beginning of 2000. Psychiatric diagnoses were obtained from 1998 and 1999 treatment records and deaths by suicide were tracked over the following seven years.
During this follow-up period, 7,684 veterans died by suicide. Slightly less than half (46.8 percent) of those who died by suicide had at least one psychiatric diagnosis, and all of the psychiatric diagnoses examined—depression, schizophrenia, bipolar disorder, substance use disorders, PTSD and other anxiety disorders—were associated with an elevated risk of suicide.
"In men, the risk of suicide was greatest for those with bipolar disorder, followed by depression, substance use disorders, schizophrenia, other anxiety disorders and PTSD," the authors write. "In women, the greatest risk of suicide was found in those with substance use disorders, followed by bipolar disorder, schizophrenia, depression, PTSD and other anxiety disorder."
Overall, the least common diagnosis—bipolar disorder—was more strongly associated with suicide than any other condition. Bipolar disorder was diagnosed in 9 percent of those who died by suicide. "This makes bipolar disorder particularly appropriate for targeted intervention efforts or attempts to improve medication adherence," the authors write.
"In all likelihood, many individuals with psychiatric disorders who were at risk for suicide were not identified by the treatment system," the authors conclude. "This could be owing to stigma, which may have made individuals less likely to report their mental health symptoms to physicians, an effect that could be more pronounced among men with military experience. These findings highlight the importance of improved identification, diagnosis and treatment of psychiatric diagnoses (particular bipolar disorder, depression, substance use disorders and schizophrenia) of all health care system users."
(Arch Gen Psychiatry. 2010;67:1152-1158. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: This work was supported by the Veterans Affairs Office of Mental Health Services, Patient Care Services and the Health Services Research and Development Service Merit Review Entry Program Award. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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Archives of General Psychiatry